Inappropriate and Appropriate Transthoracic Echocardiograms
Conditions
Keywords
Transthoracic echocardiograms, Appropriate Use Criteria, Medical Education
Brief summary
The utilization of transthoracic echocardiography in the United States has been increasing. This has resulted in increased costs to the healthcare system. In an effort to curb excessive utilization of this technology, the American College of Cardiology created Appropriate Use Criteria to help guide clinicians to use this diagnostic imaging modality more appropriately. The investigators previously showed that an educational intervention can reduce the rate of inappropriate echocardiograms ordered by physicians-in-training. It is unknown if such an intervention would be successful in attending, staff level of physicians. The investigators hypothesize that an educational and feedback intervention will reduce the rate of inappropriate outpatient transthoracic echocardiograms ordered by staff cardiologists and internal medicine physicians.
Detailed description
In response to increasing utilization of echocardiography, the American Society of Echocardiography along with the American College of Cardiology released Appropriate Use Criteria (AUC) for transthoracic echocardiography (TTE) in 2007, and these have been subsequently updated in 2011. TTE ordering patterns have been evaluated and have shown that between 15-30% of TTE ordered are inappropriate. The highest rate of inappropriate TTE is found in the outpatient environment, where routine or surveillance studies are common. These studies have also found that internists and cardiologists order the majority of TTE. The investigators previously documented that an AUC-based educational and feedback intervention reduced the rate of inappropriate TTE by cardiology and internal medicine physicians-in-training. Whether this type of intervention can improve TTE ordering of attending level physicians is not known.
Interventions
BEHAVIORALEducational Intervention
Sponsors
Massachusetts General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Cardiology Attending physicians at Massachusetts General Hospital * Primary care physicians at Massachusetts General Hospital
Exclusion criteria
* Physicians-in-training
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Inappropriate transthoracic echocardiograms | 12 months | Rate of inappropriate echocardiograms determined from a review of the electronic medical record. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Appropriate transthoracic echocardiograms | 12 months | Rate of appropriate transthoracic echocardiograms determined from a review of the electronic medical record. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Clinical reasons for appropriate and inappropriate transthoracic echocardiograms | 12 months | All echocardiograms will be classified according to the Appropriate Use Criteria (AUC). This will allow for determination of the most common clinical indications for both appropriate and inappropriate echocardiograms. |
Countries
United States
Contacts
Primary ContactRory B Weiner, MD
Outcome results
None listed